New rule on when to have a trauma surgeon meet a transported trauma patient is found more sensitive than existing criteria
An evidence-based rule to determine the need to involve a trauma surgeon with a transported patient from the time of his (or her) arrival at a trauma center has higher sensitivity, while being less complex to implement, than the existing standard, a new study finds. Emergency departments (EDs) in the United States deal with 41 million trauma cases each year, which account for substantial ED resources and health care expenditures. After the decision to transport an injured patient to a trauma center, the ED physician uses standard rules to identify those few trauma patients who need immediate attention by a trauma surgeon upon arrival. This could be a procedure such as opening the chest to access the heart or lungs.
The researchers compared the predictive accuracy of a rule developed at Loma Linda University Medical Center, consisting of three criteria, to the standard required by the American College of Surgeons (ACS), consisting of six major resuscitation criteria. Emergency surgery or procedural intervention was required in 5.3 percent of 20,872 patients registered over 13 years in the regional trauma center's registry. The trauma patients who received emergency intervention (EI) were more likely to be male, younger in age, and more seriously injured than those without emergency intervention. Injuries requiring EI were much more likely to be due to a penetrating event—a gunshot wound or stab wound—than blunt force. The sensitivity (fraction of trauma patients receiving EI who met the criteria) of the Loma Linda rule was 95.6 percent versus 85.5 percent for the ACS standard, while the Loma Linda rule's specificity (fraction of those not receiving EI who did not meet the criteria) was 56.3 percent versus 80.9 percent for the ACS standard.
When the researchers made minor adjustments to the Loma Linda rule—while keeping it to 3 simple criteria—the refined Loma Linda rule's predictive accuracy improved (sensitivity = 89.7 percent and specificity = 75.2 percent). The study was supported in part by the Agency for Healthcare Research and Quality (HS17526).
More details are in "Validation and refinement of a rule to predict emergency intervention in adult trauma patients," by Jason S. Haukoos, M.D., M.Sc., Richard L. Byyny, M.D., M.Sc., Catherine Erickson, M.D., and others in the 20 September 2011 Annals of Emergency Medicine; 155(6); pp. 353-360.
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